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C-reactive protein-triglyceride glucose index predicts stroke incidence in a hypertensive population: a national cohort study.
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-21 DOI: 10.1186/s13098-024-01529-z
Songyuan Tang, Han Wang, Kunwei Li, Yaqing Chen, Qiaoqi Zheng, Jingjing Meng, Xin Chen

Background: Both the triglyceride-glucose (TyG) index, a predictor of insulin resistance (IR), and inflammation are risk factors for stroke in hypertensive patients. However, only a handful of studies have coupled the TyG index and inflammation indices to predict stroke risk in hypertensive patients. The C-reactive protein-triglyceride-glucose index (CTI) is a novel marker that comprehensively assesses the severity of IR and inflammation. The present study explored the association between CTI and the risk of stroke in patients with hypertension.

Methods: A total of 3,834 hypertensive patients without a history of stroke at baseline were recruited from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate Cox regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between CTI and stroke risk in hypertensive patients. Furthermore, the Boruta algorithm was applied to evaluate the importance of CTI and construct prediction models to forecast the incidence of stroke in the study cohort.

Results: After 7 years of follow-up, the incidence of stroke in hypertensive patients was 9.6% (368 cases). Multivariate Cox regression analysis revealed a 21% increase in stroke risk with an increase in each CTI unit (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.08-1.37). The top quartile group was 66% more likely to have a stroke than the bottom quartile group (HR = 1.66, 95% CI = 1.23-2.25). RCS analysis confirmed a linear relationship between CTI and stroke risk. The Boruta algorithm validated CTI as a crucial indicator of stroke risk. The Support Vector Machine (SVM) survival model exhibited the best predictive performance for stroke risk in hypertensive patients, with an area under the curve (AUC) of 0.956.

Conclusions: An increase in CTI levels is associated with a higher risk of stroke in hypertensive patients. This study suggests that CTI may emerge as a unique predictive marker for stroke risk.

背景:甘油三酯-葡萄糖(TyG)指数(胰岛素抵抗(IR)的预测指标)和炎症都是高血压患者卒中的危险因素。然而,只有少数研究将 TyG 指数和炎症指数结合起来预测高血压患者的中风风险。C 反应蛋白-甘油三酯-葡萄糖指数(CTI)是一种全面评估 IR 和炎症严重程度的新型标记物。本研究探讨了 CTI 与高血压患者中风风险之间的关系:中国健康与退休纵向研究(CHARLS)共招募了 3834 名基线无脑卒中病史的高血压患者。采用多变量 Cox 回归和限制性立方样条曲线(RCS)分析评估 CTI 与高血压患者脑卒中风险之间的关系。此外,还应用 Boruta 算法评估 CTI 的重要性,并构建预测模型来预测研究队列中的中风发病率:随访 7 年后,高血压患者的中风发病率为 9.6%(368 例)。多变量 Cox 回归分析显示,CTI 单位每增加一个,中风风险就增加 21%(危险比 (HR) = 1.21,95% 置信区间 (CI) = 1.08-1.37)。前四分位组发生中风的几率比后四分位组高出 66%(HR = 1.66,95% CI = 1.23-2.25)。RCS 分析证实 CTI 与中风风险之间存在线性关系。Boruta 算法证实 CTI 是中风风险的关键指标。支持向量机(SVM)生存模型对高血压患者中风风险的预测效果最佳,其曲线下面积(AUC)为 0.956:CTI水平的升高与高血压患者中风风险的升高有关。结论:CTI 水平的升高与高血压患者中风风险的升高有关。本研究表明,CTI 可能成为中风风险的独特预测标志物。
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引用次数: 0
Investigation of renal tubular function with newly diagnosed type 1 diabetes mellitus during diabetic ketoacidosis. 对糖尿病酮症酸中毒期间新诊断的 1 型糖尿病患者肾小管功能的调查。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-20 DOI: 10.1186/s13098-024-01506-6
Naonori Kumagai, Hiroki Takao, Yuta Sudo, Masatoshi Yoshikane, Tomomi Kondoh, Yuji Matsumoto, Haruo Mizuno, Michiaki Abe, Yohei Ikezumi

Background: Proximal renal tubular dysfunction occurs during diabetic ketoacidosis (DKA) in type 1 diabetes. However, only a few studies have reported on the multiple proximal renal tubular functions simultaneously. Moreover, to the best of our knowledge, distal renal tubular function has not yet been investigated.

Methods: Patients with newly diagnosed type 1 diabetes mellitus were classified into those with DKA and those without DKA, and their proximal and distal renal tubular functions were investigated. The diagnostic criteria for DKA were blood glucose > 200 mg/dL, blood pH < 7.3 or HCO3- < 15 mEq/L, and urine ketone body positivity.

Results: Six patients with DKA and five patients without DKA were included. In patients with DKA, urinary β2-microglobulin levels were significantly higher, while blood pH, HCO3-, and tubular reabsorption of phosphorus were significantly lower than in those without DKA. There were no significant differences in blood glucose, HbA1c, serum phosphorus, urinary N-acetyl-beta-glucosaminidase, and urinary amino acid excretion between patients with and without DKA. Elevated NH3 levels and impaired urinary acidification were not observed in patients with and without DKA.

Conclusions: In patients with newly diagnosed type 1 diabetes mellitus complicated with DKA, multiple proximal renal tubular dysfunctions occur simultaneously, suggesting transient Fanconi syndrome. Distal renal tubular acidosis was unlikely. The diagnostic criteria for DKA are appropriate also in the view of proximal renal tubular dysfunction and are considered suggestive of pathophysiological factors that may cause proximal renal tubular dysfunction.

背景:1 型糖尿病患者在发生糖尿病酮症酸中毒(DKA)时会出现近端肾小管功能障碍。然而,只有少数几项研究同时报道了近端肾小管的多种功能。此外,据我们所知,远端肾小管功能尚未得到研究:方法:将新确诊的 1 型糖尿病患者分为 DKA 患者和非 DKA 患者,并调查他们的近端和远端肾小管功能。DKA 的诊断标准为血糖 > 200 mg/dL、血液 pH 3- 结果:共纳入 6 名 DKA 患者和 5 名非 DKA 患者。与无 DKA 患者相比,DKA 患者的尿β2-微球蛋白水平明显升高,而血液 pH 值、HCO3- 和肾小管对磷的重吸收则明显降低。患有和未患有 DKA 的患者在血糖、HbA1c、血清磷、尿液中 N-乙酰-beta-葡萄糖苷酶和尿液氨基酸排泄量方面没有明显差异。在有 DKA 和无 DKA 的患者中均未观察到 NH3 水平升高和尿酸化受损的情况:结论:在新诊断的 1 型糖尿病并发 DKA 患者中,多种近端肾小管功能障碍同时发生,提示存在一过性范可尼综合征。远端肾小管酸中毒的可能性不大。从近端肾小管功能障碍的角度来看,DKA的诊断标准也是适当的,并被认为提示了可能导致近端肾小管功能障碍的病理生理因素。
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引用次数: 0
Preclinical evidence and possible mechanisms of cardioprotective effects of resveratrol in diabetic cardiomyopathy: a systematic review and meta-analysis. 白藜芦醇对糖尿病心肌病具有心脏保护作用的临床前证据和可能机制:系统综述和荟萃分析。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-17 DOI: 10.1186/s13098-024-01512-8
Xiaodan Yan, Youjia Hu, Shuyuan Zhao, Qian Zhou, Qiu Chen

Introduction: Diabetic cardiomyopathy (DCM) is a significant complication of diabetes, characterized primarily by the development of heart failure in individuals with diabetes. Numerous animal studies have indicated that resveratrol enhances cardiac function in diabetic cardiomyopathy; however, its reliability and underlying mechanism remain unclear. This study aims to assess the cardioprotective effects of resveratrol on DCM and explore its potential mechanism.

Methods: We searched PubMed, EMBASE, WOS, Cochrane Library, CNKI, CBM, Chinese VIP, and Wan Fang Database until March 31st, 2024, without language restrictions. Continuous outcome measures were analyzed using weighted mean difference or standardized mean difference, and heterogeneity was assessed with I2. The risk of bias in animal experiments was evaluated using the SYRCLE tool, and evidence reliability was determined with the GRADE tool. All data were analyzed using Review Manager 5.4.1 and Stata 17. This study has been registered on the PROSPERO (CRD42024523944).

Results: A total of 18 studies meeting the criteria were identified. The analysis revealed that the resveratrol intervention group exhibited significant improvements in LVEF (WMD = 17.88), LVFS (WMD = 8.77), HW/BW (SMD=-2.92), SOD (SMD = 4.53), and MDA (SMD=-5.07) compared to the control group. The GRADE grading assessment indicated moderate certainty for LVEF, HW/BW, and MDA, while certainty for other factors was considered low.

Conclusion: Our research suggests that resveratrol may protect cardiac function in DCM through anti-inflammatory and anti-oxidative stress effects. However, these findings are based on preclinical data, and further extensive trials are needed to confirm their effectiveness and safety before clinical application.

简介:糖尿病心肌病(DCM)是糖尿病的一种重要并发症,主要表现为糖尿病患者出现心力衰竭。大量动物实验表明,白藜芦醇能增强糖尿病心肌病患者的心脏功能,但其可靠性和内在机制仍不清楚。本研究旨在评估白藜芦醇对糖尿病心肌病的心脏保护作用,并探索其潜在机制:我们检索了 PubMed、EMBASE、WOS、Cochrane Library、CNKI、CBM、Chinese VIP 和万方数据库,检索时间截至 2024 年 3 月 31 日,无语言限制。连续结果指标采用加权平均差或标准化平均差进行分析,异质性采用 I2 进行评估。使用 SYRCLE 工具评估动物实验的偏倚风险,使用 GRADE 工具确定证据的可靠性。所有数据均使用 Review Manager 5.4.1 和 Stata 17 进行分析。本研究已在 PROSPERO(CRD42024523944)上注册:共有 18 项研究符合标准。分析表明,与对照组相比,白藜芦醇干预组的 LVEF(WMD=17.88)、LVFS(WMD=8.77)、HW/BW(SMD=-2.92)、SOD(SMD=4.53)和 MDA(SMD=-5.07)均有显著改善。GRADE分级评估显示,LVEF、HW/BW和MDA的确定性为中等,而其他因素的确定性被认为较低:我们的研究表明,白藜芦醇可通过抗炎和抗氧化应激作用保护 DCM 的心脏功能。结论:我们的研究表明,白藜芦醇可通过抗炎和抗氧化应激作用保护 DCM 患者的心脏功能。然而,这些研究结果是基于临床前数据得出的,在临床应用之前,还需要进行进一步的广泛试验,以确认其有效性和安全性。
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引用次数: 0
Is there a genetic relationship between blood glucose and osteoarthritis? A mendelian randomization study. 血糖与骨关节炎之间存在遗传关系吗?亡羊补牢式随机研究
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-14 DOI: 10.1186/s13098-024-01517-3
Junxiang Wang, Leixuan Peng, Mingyi Yang, Jiachen Wang, Ruoyang Feng, Ke Xu, Peng Xu

Objective: The relationship between blood glucose levels and osteoarthritis (OA) is unclear. This study aimed to investigate the genetic causal relationship between blood glucose-related traits and OA.

Methods: We first performed univariate Mendelian randomization (UVMR) analyses using published genome-wide association study (GWAS) datasets with fasting glucose (FG), 2 h-glucose post-challenge glucose (2hGlu), and glycosylated hemoglobin (HbA1c) as exposures, and hip osteoarthritis (HOA) and knee osteoarthritis (KOA) as outcomes; then, we performed inverse analyses of them. We used Inverse-variance weighted (IVW) analysis as the primary analysis, and sensitivity analyses were performed. Moreover, we performed multivariate Mendelian randomization (MVMR) to estimate the independent effect of exposure on outcome after adjusting for body mass index (BMI). Summarized data for blood glucose-related traits were obtained from the MAGIC Consortium study of the glucose trait genome and for OA from the UK Biobank and arcOGEN. Summarized data for BMI were obtained from the GIANT Consortium meta-analysis of individuals of European ancestry. A two-sided p value < 0.05 in UVMR was considered suggestive of significance when p < 0.0167 (Bonferroni correction p = 0.05/3 exposures) was considered statistically significant.

Results: We found significant negative genetic causality of FG for HOA and KOA, and these associations remained significant after we adjusted for the effect of BMI [odds ratios (ORs) of 0.829 (0.687-0.999, p = 0.049) and 0.741 (0.570-0.964, p = 0.025)]. HbA1c also had an independent negative genetic causal effect on HOA after adjustment for BMI [0.665 (0.463-0.954, p = 0.027)]. At the same time, there was no evidence of reverse genetic causality of OA on blood glucose-related traits.

Conclusion: We further elucidated the relationship between blood glucose-related traits and OA by adjusting for the effect of BMI from a genetic causal perspective. This study provides new insights to further clarify the relationship between blood glucose levels and OA, as well as the pathogenesis, etiology and genetics of OA.

目的:血糖水平与骨关节炎(OA)之间的关系尚不清楚。本研究旨在探讨血糖相关性状与 OA 之间的遗传因果关系:我们首先使用已发表的全基因组关联研究(GWAS)数据集进行了单变量孟德尔随机化(UVMR)分析,以空腹血糖(FG)、2 h-葡萄糖挑战后血糖(2hGlu)和糖化血红蛋白(HbA1c)为暴露,以髋关节骨关节炎(HOA)和膝关节骨关节炎(KOA)为结局;然后,我们对它们进行了逆分析。我们使用逆方差加权(IVW)分析作为主要分析,并进行了敏感性分析。此外,我们还进行了多变量孟德尔随机分析(MVMR),以估计在调整体重指数(BMI)后暴露对结果的独立影响。血糖相关性状的汇总数据来自 MAGIC Consortium 葡萄糖性状基因组研究,OA 的汇总数据来自英国生物库和 arcOGEN。体重指数的汇总数据来自 GIANT 联合会对欧洲血统个体的荟萃分析。结果我们发现 FG 对 HOA 和 KOA 有明显的负遗传因果关系,在对 BMI 的影响进行调整后,这些关联仍然显著[几率比(ORs)分别为 0.829 (0.687-0.999, p = 0.049) 和 0.741 (0.570-0.964, p = 0.025)]。调整体重指数后,HbA1c 对 HOA 也有独立的负遗传因果效应 [0.665 (0.463-0.954, p = 0.027)]。同时,没有证据表明 OA 对血糖相关性状具有反向遗传因果关系:我们从遗传因果关系的角度,通过调整体重指数的影响,进一步阐明了血糖相关性状与 OA 之间的关系。这项研究为进一步阐明血糖水平与 OA 之间的关系,以及 OA 的发病机制、病因学和遗传学提供了新的见解。
{"title":"Is there a genetic relationship between blood glucose and osteoarthritis? A mendelian randomization study.","authors":"Junxiang Wang, Leixuan Peng, Mingyi Yang, Jiachen Wang, Ruoyang Feng, Ke Xu, Peng Xu","doi":"10.1186/s13098-024-01517-3","DOIUrl":"10.1186/s13098-024-01517-3","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between blood glucose levels and osteoarthritis (OA) is unclear. This study aimed to investigate the genetic causal relationship between blood glucose-related traits and OA.</p><p><strong>Methods: </strong>We first performed univariate Mendelian randomization (UVMR) analyses using published genome-wide association study (GWAS) datasets with fasting glucose (FG), 2 h-glucose post-challenge glucose (2hGlu), and glycosylated hemoglobin (HbA1c) as exposures, and hip osteoarthritis (HOA) and knee osteoarthritis (KOA) as outcomes; then, we performed inverse analyses of them. We used Inverse-variance weighted (IVW) analysis as the primary analysis, and sensitivity analyses were performed. Moreover, we performed multivariate Mendelian randomization (MVMR) to estimate the independent effect of exposure on outcome after adjusting for body mass index (BMI). Summarized data for blood glucose-related traits were obtained from the MAGIC Consortium study of the glucose trait genome and for OA from the UK Biobank and arcOGEN. Summarized data for BMI were obtained from the GIANT Consortium meta-analysis of individuals of European ancestry. A two-sided p value < 0.05 in UVMR was considered suggestive of significance when p < 0.0167 (Bonferroni correction p = 0.05/3 exposures) was considered statistically significant.</p><p><strong>Results: </strong>We found significant negative genetic causality of FG for HOA and KOA, and these associations remained significant after we adjusted for the effect of BMI [odds ratios (ORs) of 0.829 (0.687-0.999, p = 0.049) and 0.741 (0.570-0.964, p = 0.025)]. HbA1c also had an independent negative genetic causal effect on HOA after adjustment for BMI [0.665 (0.463-0.954, p = 0.027)]. At the same time, there was no evidence of reverse genetic causality of OA on blood glucose-related traits.</p><p><strong>Conclusion: </strong>We further elucidated the relationship between blood glucose-related traits and OA by adjusting for the effect of BMI from a genetic causal perspective. This study provides new insights to further clarify the relationship between blood glucose levels and OA, as well as the pathogenesis, etiology and genetics of OA.</p>","PeriodicalId":11106,"journal":{"name":"Diabetology & Metabolic Syndrome","volume":"16 1","pages":"274"},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Simvastatin reduces chronic kidney disease and renal failure risk in type 2 diabetes patients: post hoc ACCORD trial analysis. 辛伐他汀可降低 2 型糖尿病患者的慢性肾病和肾衰竭风险:ACCORD 试验的事后分析。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-14 DOI: 10.1186/s13098-024-01514-6
Jiaxi Pu, Ming Gao, Pan Yu, Jiaqi Tian, Junxia Yan, Qiongjing Yuan, Lijian Tao, Zhangzhe Peng

Objective: Type 2 diabetes mellitus (T2DM) poses a substantial global health concern. Statins are widely used among T2DM patients for managing dyslipidemia, preventing cardiovascular disease (CVD), and offering renal protection. However, the extent to which their renal protective effects contribute to reducing the incidence of severe renal complications, including chronic kidney disease (CKD) and renal failure, is not well-defined.

Methods: This investigation scrutinizes the impact of simvastatin versus placebo on renal outcomes among T2DM patients utilizing data from the ACCORD trial. It encompasses incidence rate comparisons, Kaplan-Meier estimates, Cox proportional hazards models, and mediation analyses.

Results: The study consisted of 3,619 individuals diagnosed with T2DM, among which 2,753 were treated routinely with simvastatin, while 866 did not receive any statin therapy. After adjusting for baseline characteristics and time-dependent covariates, simvastatin treatment was associated with a 71% reduction in the risk of CKD (HR 0.29, 95% CI 0.27-0.31, p < 0.01) and a 47% reduction in the risk of renal failure (HR 0.53, 95% CI 0.44-0.65, p < 0.01) compared to the statin-free group. Further subgroup analysis, accounting for the initial lipid and kidney profiles, indicated variable impacts of simvastatin on CKD and renal failure outcomes. Nevertheless, a consistent reduction in CKD risk was observed across all subgroups within the statin-treated population. Additional mediation analysis revealed that the reduction in low-density lipoprotein cholesterol (LDL-C) may be a potential mediator in the association between simvastatin and CKD, with a mediation effect of 14.9%, (95% CI 0.11-0.19, p < 0.01).

Conclusion: Administering statins, specifically simvastatin, to T2DM patients at elevated risk for CVD, is likely to offer augmented renal advantages, notably in lowering the occurrence of CKD and renal failure. This protective effect against CKD manifests regardless of initial lipid profiles, albuminuria, and estimated glomerular filtration rate (eGFR) levels. The association between simvastatin and CKD may be partially mediated by LDL-C reduction.

目的:2 型糖尿病(T2DM)是全球关注的重大健康问题。他汀类药物在 T2DM 患者中被广泛用于控制血脂异常、预防心血管疾病(CVD)和保护肾脏。然而,他汀类药物对肾脏的保护作用在多大程度上有助于降低慢性肾脏病(CKD)和肾衰竭等严重肾脏并发症的发病率,目前还没有明确的定义:本研究利用 ACCORD 试验的数据,仔细研究了辛伐他汀与安慰剂相比对 T2DM 患者肾脏预后的影响。研究包括发病率比较、Kaplan-Meier估计、Cox比例危险模型和中介分析:研究对象包括 3,619 名确诊为 T2DM 的患者,其中 2,753 人常规接受辛伐他汀治疗,866 人未接受任何他汀类药物治疗。在调整了基线特征和随时间变化的协变量后,辛伐他汀治疗可使患 CKD 的风险降低 71%(HR 0.29,95% CI 0.27-0.31,p 结论:辛伐他汀治疗可使患 CKD 的风险降低 71%(HR 0.29,95% CI 0.27-0.31,p 结论):给心血管疾病风险较高的 T2DM 患者服用他汀类药物,特别是辛伐他汀,可能会增强肾脏的优势,尤其是在降低 CKD 和肾衰竭的发生率方面。这种对慢性肾功能衰竭的保护作用不受初始血脂、白蛋白尿和估计肾小球滤过率(eGFR)水平的影响。辛伐他汀与慢性肾功能衰竭之间的联系可能部分是由降低低密度脂蛋白胆固醇介导的。
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引用次数: 0
Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy. 早期连续血糖监测得出的血糖模式与随后的胰岛素抵抗和孕期妊娠糖尿病的发生有关。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-14 DOI: 10.1186/s13098-024-01508-4
Chee Wai Ku, Ruther Teo Zheng, Hong Ying Tan, Jamie Yong Qi Lim, Ling-Wei Chen, Yin Bun Cheung, Keith M Godfrey, Jerry Kok Yen Chan, Fabian Yap, Ngee Lek, See Ling Loy

Background: Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM).

Methods: CGM measurements were taken for 3-10 days at 18-24 weeks' gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24-28 weeks' gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape.

Results: This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7 years, body mass index of 22.9 kg/m2, and gestation of 20.3 weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24 h.

Conclusions: In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy.

背景:妊娠糖尿病(GDM)和胰岛素抵抗(IR)会增加不良妊娠结局的风险。我们旨在研究妊娠早期通过连续血糖监测(CGM)评估的间质葡萄糖与随后发生的 IR 和 GDM 之间的关系,并确定血糖状态正常(非 IR 和非 GDM)和血糖状态不达标(IR 和/或 GDM)妇女的 24 小时间质葡萄糖百分位数分布:在妊娠 18-24 周时进行为期 3-10 天的 CGM 测量,然后在妊娠 24-28 周时进行空腹血清胰岛素和口服葡萄糖耐量试验。IR和GDM分别根据更新的体内平衡模型评估IR评分≥1.22和2013年世界卫生组织标准确定。采用改良泊松模型估计IR和GDM的风险,并采用位置、规模和形状的广义加性模型确定每小时间质葡萄糖百分位数:这项前瞻性队列研究涉及新加坡的 167 名孕妇,她们的平均年龄为 31.7 岁,体重指数为 22.9 kg/m2,妊娠期为 20.3 周。25%的孕妇表现为IR,18%的孕妇出现了GDM。在对混杂因素进行调整后,血糖控制不理想的妇女(表现为较高的日平均血糖(风险比 1.42;95% 置信区间 1.16,1.73)、血糖管理指标(1.08;1.03,1.12)和 J 指数(1.04;1.02,1.在妊娠早期,血糖管理指标(1.08;1.03,1.12)和 J 指数(1.04;1.02,1.06)显示血糖变异性较大,标准偏差(1.69;1.37,2.09)、变异系数(1.03;1.00,1.06)和血糖偏移平均振幅(1.4;1.14,1.35)较高。在 GDM 的发生方面也观察到了类似的关联。百分位曲线显示,与血糖状态正常的孕妇相比,血糖状态不达标的孕妇血糖水平更高,且在 24 小时内波动更大:结论:在随后发展为 IR 和 GDM 的孕妇中,CGM 评估的间质葡萄糖水平升高且变化很大。这支持了使用 CGM 筛查妊娠早期血糖变化的可能性。
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引用次数: 0
Metformin plus lifestyle interventions versus lifestyle interventions alone for the delay or prevention of type 2 diabetes in individuals with prediabetes: a meta-analysis of randomized controlled trials. 二甲双胍加生活方式干预与单纯生活方式干预在延缓或预防糖尿病前期患者 2 型糖尿病方面的比较:随机对照试验荟萃分析。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-14 DOI: 10.1186/s13098-024-01504-8
Basma Ehab Amer, Mahmoud Shaaban Abdelgalil, Abdullah Ashraf Hamad, Kerollos Abdelsayed, Ahmed Elaraby, Ahmed Mohamed Abozaid, Mohamed Abd-ElGawad

Objectives: We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes.

Materials and methods: We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the "meta" package of RStudio software.

Results: We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes.

Conclusions: Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.

目的:我们对随机对照试验(RCT)进行了荟萃分析:我们对随机对照试验(RCTs)进行了荟萃分析,以比较在生活方式干预中添加二甲双胍与单独使用生活方式干预对糖尿病前期患者的疗效:我们检索了从开始到 2024 年 3 月 20 日的四个数据库。我们的主要结果包括 2 型糖尿病的发病率、血红蛋白 A1c (HbA1c) 和空腹血浆葡萄糖 (FPG)。次要结果包括血压、血浆脂质和体重测量值。二分结果以风险比(RR)及其 95% 置信区间(CI)进行汇总,连续结果以随机效应模型中的标准化平均差(SMD)及其 95% 置信区间进行汇总。所有统计分析均使用 RStudio 软件的 "meta "软件包进行:结果:我们纳入了 12 项 RCT,共 2720 名患者。在生活方式干预中加入二甲双胍可显著降低 HbA1c 水平(SMD = -0.10,95% CI [-0.19,-0.01],P = 0.03)和 2 型糖尿病发病率(RR = 0.85,95% CI [0.75,0.97],P = 0.01)。有趣的是,在生活方式干预的基础上加用二甲双胍,3 个月和 6 个月的 FPG 与单独使用生活方式干预的结果相当;但 12 个月的 FPG 显著降低(SMD = -0.34,95% CI [-0.59,-0.08],P =0.01)。在所有次要结果方面,两组之间没有明显差异:我们的研究结果表明,与单纯的生活方式干预相比,在生活方式干预中加入二甲双胍可改善糖尿病前期患者的血糖控制,并降低其发展为糖尿病的风险。要观察到预期效果,可能需要延长这种联合方法的持续时间。
{"title":"Metformin plus lifestyle interventions versus lifestyle interventions alone for the delay or prevention of type 2 diabetes in individuals with prediabetes: a meta-analysis of randomized controlled trials.","authors":"Basma Ehab Amer, Mahmoud Shaaban Abdelgalil, Abdullah Ashraf Hamad, Kerollos Abdelsayed, Ahmed Elaraby, Ahmed Mohamed Abozaid, Mohamed Abd-ElGawad","doi":"10.1186/s13098-024-01504-8","DOIUrl":"10.1186/s13098-024-01504-8","url":null,"abstract":"<p><strong>Objectives: </strong>We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes.</p><p><strong>Materials and methods: </strong>We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the \"meta\" package of RStudio software.</p><p><strong>Results: </strong>We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes.</p><p><strong>Conclusions: </strong>Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.</p>","PeriodicalId":11106,"journal":{"name":"Diabetology & Metabolic Syndrome","volume":"16 1","pages":"273"},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between sarcopenia and the foot-ankle function in type 2 diabetic foot ulcer. 肌肉疏松症与 2 型糖尿病足溃疡患者足踝功能之间的关系。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-13 DOI: 10.1186/s13098-024-01507-5
Shujing An, Weina Kuang, Yonglu Hu, Xinwei Li, Bingzi Dong, Chengqian Li, Yangang Wang

Background: The diabetic foot (DF) ulcer is the severe complication of type 2 diabetes mellitus (T2DM). Sarcopenia is characterized as the loss of muscle mass and strength, resulting in the increased risk of fracture and physical disability. Sarcopenia may affect the foot-ankle function in DF ulcer patients, compromise the quality of life.

Objective: The aim was to clarify the effect of sarcopenia on foot-ankle function in patients with DF ulcer.

Methods: In total of 108 T2DM patients with DF ulcer were enrolled. Based on the examination of muscle mass by dual energy X-ray absorptiometry (DXA) and grip strength and 5x sit-to-stand test, the DF patients were divided into sarcopenia and non-sarcopenia groups. The severity of DF ulcer was evaluated by Wagner classification. The foot-ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.

Results: DF patients with sarcopenia showed advanced age, lower BMI, longer duration of T2DM, and more severe Wagner classification, reduced appendicular skeletal muscle mass index (ASMI), grip strength, transcutaneous oxygenpressure (TcPO2) and prolonged time of 5X sit-to-stand test. The stratified comparison analysis indicated that severity of sarcopenia and DF ulcer, reduced TcPO2, and grip strength were aggravated with the impaired foot-ankle function (P < 0.05). Multivariate Logistic analysis showed that age, TcPO2, and severe sarcopenia were risk factors deteriorating the foot-ankle function.

Conclusion: The sarcopenia is a key risk factor of decreasing foot-ankle function in patients with DF ulcer. Thus, the prevention of muscle mass and strength loss could be considered as part of comprehensive therapy for DF ulcer.

背景:糖尿病足(DF)溃疡是 2 型糖尿病(T2DM)的严重并发症。肌肉疏松症的特点是肌肉质量和力量的丧失,导致骨折和身体残疾的风险增加。肌肉疏松症可能会影响 DF 溃疡患者的足踝功能,影响其生活质量:目的:阐明肌肉疏松症对 DF 溃疡患者足踝功能的影响:方法:共纳入 108 名患有 DF 溃疡的 T2DM 患者。根据双能 X 光吸收测定法(DXA)、握力和 5 倍坐立测试对肌肉质量的检测结果,将 DF 患者分为肌肉疏松症组和非肌肉疏松症组。用瓦格纳分类法评估 DF 溃疡的严重程度。美国骨科足踝协会(AOFAS)踝-后足评分评估了足踝功能:结果:患有 "肌肉疏松症 "的 DF 患者年龄较大,体重指数较低,T2DM 持续时间较长,瓦格纳分类较严重,骨骼肌质量指数(ASMI)、握力、经皮氧压(TcPO2)降低,5 倍坐立测试时间延长。分层比较分析表明,肌肉疏松症和 DF 溃疡的严重程度、TcPO2 降低和握力会加重足踝功能受损(P 2),严重的肌肉疏松症是足踝功能恶化的危险因素:结论:肌肉疏松症是导致 DF 溃疡患者足踝功能下降的关键风险因素。因此,预防肌肉质量和力量下降可被视为综合治疗 DF 溃疡的一部分。
{"title":"Association between sarcopenia and the foot-ankle function in type 2 diabetic foot ulcer.","authors":"Shujing An, Weina Kuang, Yonglu Hu, Xinwei Li, Bingzi Dong, Chengqian Li, Yangang Wang","doi":"10.1186/s13098-024-01507-5","DOIUrl":"10.1186/s13098-024-01507-5","url":null,"abstract":"<p><strong>Background: </strong>The diabetic foot (DF) ulcer is the severe complication of type 2 diabetes mellitus (T2DM). Sarcopenia is characterized as the loss of muscle mass and strength, resulting in the increased risk of fracture and physical disability. Sarcopenia may affect the foot-ankle function in DF ulcer patients, compromise the quality of life.</p><p><strong>Objective: </strong>The aim was to clarify the effect of sarcopenia on foot-ankle function in patients with DF ulcer.</p><p><strong>Methods: </strong>In total of 108 T2DM patients with DF ulcer were enrolled. Based on the examination of muscle mass by dual energy X-ray absorptiometry (DXA) and grip strength and 5x sit-to-stand test, the DF patients were divided into sarcopenia and non-sarcopenia groups. The severity of DF ulcer was evaluated by Wagner classification. The foot-ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.</p><p><strong>Results: </strong>DF patients with sarcopenia showed advanced age, lower BMI, longer duration of T2DM, and more severe Wagner classification, reduced appendicular skeletal muscle mass index (ASMI), grip strength, transcutaneous oxygenpressure (TcPO<sub>2</sub>) and prolonged time of 5X sit-to-stand test. The stratified comparison analysis indicated that severity of sarcopenia and DF ulcer, reduced TcPO<sub>2</sub>, and grip strength were aggravated with the impaired foot-ankle function (P < 0.05). Multivariate Logistic analysis showed that age, TcPO<sub>2</sub>, and severe sarcopenia were risk factors deteriorating the foot-ankle function.</p><p><strong>Conclusion: </strong>The sarcopenia is a key risk factor of decreasing foot-ankle function in patients with DF ulcer. Thus, the prevention of muscle mass and strength loss could be considered as part of comprehensive therapy for DF ulcer.</p>","PeriodicalId":11106,"journal":{"name":"Diabetology & Metabolic Syndrome","volume":"16 1","pages":"270"},"PeriodicalIF":3.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phase angle and body composition in long-term type 1 diabetes in adults: a comparative study in a Brazilian public reference outpatient clinic. 相位角与成人长期 1 型糖尿病患者的身体成分:巴西公共参考门诊的一项比较研究。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-13 DOI: 10.1186/s13098-024-01485-8
Natália Fenner-Pena, Virgínia Capistrano Fajardo, Lívia Froes, Paulo Augusto Miranda Carvalho, Fábio Vasconcellos Comim, Viviane Sahade, Márcio Weissheimer Lauria, Henrique Oswaldo da Gama Torres

Introduction: Type 1 Diabetes Mellitus (DM1) affects a small percentage of the population. Nevertheless, its prevalence is currently growing with alarming data on uncontrolled cases. The importance of body composition and Phase Angle (PA), assessed by Bioelectrical Impedance (BIA), in long- term DM1 patients lies in the fact that alterations in cellular integrity and body compartments may affect risk profiles and metabolic control. The objective of this study was to compare PA and body composition parameters between adults with DM1 and healthy controls.

Methods: A comparative study was carried out in a public university outpatient clinic including a cohort of adult patients of both sexes diagnosed with DM1 and healthy controls matched by age and sex in a 2:1 ratio. Anthropometric measurements included weight, height and BMI. Using the raw BIA data of Resistance and Reactance, fat-free mass (FFM), fat mass (FM), fat-free mass index (FFMI), fat mass index (FMI), PA and standardized PA (SPA) were calculated. Means or medians were compared between the groups. Regression models were used to identify distinguishing characteristics of the groups and associations within the DM1 group (i.e. glycated hemoglobin (HbA1c), disease duration, presence of microvascular complications, capillary blood glucose, BMI and FMI).

Results: 88 patients with DM1and 46 healthy controls were evaluated. PA (6.05 vs. 6.85, p = 0.000) and SPA (-1.47 vs. -0,37, p = 0.000) were lower in patients with DM1 compared to healthy controls. People with DM1 displayed higher adiposity (%FM = 29.6 vs. 27.6, p = 0.016; FMI = 7.00 vs. 6.33, p = 0.016) and lower %FFM compared to healthy controls. Most of the differences were maintained after sex stratification; however, men with DM1 showed a lower FFMI than male controls (18.2 vs. 20.16, p = 0.029).

Conclusion: Patients with DM1 present lower PA than healthy controls, which may be related to worse cell membrane integrity. Significant body composition differences between the groups and between sexes were identified, with data showing greater adiposity in women with DM1 and men displaying lower muscle mass. These findings suggest the importance of including PA and body composition evaluations in the follow-up of patients with DM1. The ultimate goal is to obtain a better metabolic control and, consequently, a better prognosis.

导言:1 型糖尿病(DM1)只影响一小部分人口。尽管如此,其发病率目前仍在增长,未控制病例的数据令人担忧。通过生物电阻抗 (BIA) 评估身体成分和相位角 (PA),对长期罹患 DM1 的患者非常重要,因为细胞完整性和身体分区的改变可能会影响风险概况和代谢控制。本研究的目的是比较 DM1 患者和健康对照组之间的 PA 和身体成分参数:在一家公立大学门诊部进行了一项比较研究,研究对象包括确诊为 DM1 的成年男女患者和按 2:1 比例进行年龄和性别匹配的健康对照组。人体测量包括体重、身高和体重指数。利用阻力和反应的原始 BIA 数据,计算出无脂质量(FFM)、脂肪质量(FM)、无脂质量指数(FFMI)、脂肪质量指数(FMI)、PA 和标准化 PA(SPA)。比较各组之间的平均值或中位数。使用回归模型确定各组的不同特征以及 DM1 组内的相关性(即糖化血红蛋白(HbA1c)、病程、是否存在微血管并发症、毛细血管血糖、BMI 和 FMI):对 88 名 DM1 患者和 46 名健康对照者进行了评估。与健康对照组相比,DM1 患者的 PA(6.05 对 6.85,P = 0.000)和 SPA(-1.47 对 -0.37,P = 0.000)较低。与健康对照组相比,DM1患者的脂肪率较高(%FM = 29.6 vs. 27.6,p = 0.016;FMI = 7.00 vs. 6.33,p = 0.016),%FFM较低。性别分层后,大部分差异得以保持;然而,男性 DM1 患者的 FFMI 值低于男性对照组(18.2 vs. 20.16,p = 0.029):结论:DM1 患者的 PA 值低于健康对照组,这可能与细胞膜完整性较差有关。组间和性别间的身体成分差异显著,数据显示女性 DM1 患者的脂肪含量更高,而男性的肌肉含量更低。这些研究结果表明,在 DM1 患者的随访中纳入 PA 和身体成分评估非常重要。最终目的是获得更好的代谢控制,从而获得更好的预后。
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引用次数: 0
Lifestyle intervention improves cardiometabolic profiles among children with metabolically healthy and metabolically unhealthy obesity. 生活方式干预可改善代谢健康和代谢不健康肥胖儿童的心脏代谢状况。
IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-11 DOI: 10.1186/s13098-024-01493-8
Ruziana Mona Wan Mohd Zin, Muhammad Yazid Jalaludin, Fuziah Md Zain, Janet Yeow Hua Hong, Nur Zati Iwani Ahmad Kamil, Abdul Halim Mokhtar, Wan Nazaimoon Wan Mohamud

Background: In recent years, there has been a surge of interest in the metabolic phenotype among children with obesity characterized by the absence of associated cardiometabolic risk factors (CRFs), known as metabolically healthy obesity (MHO), as opposed to those with metabolically unhealthy obesity (MUO). This study investigated the effect of lifestyle intervention on CRFs among children with MHO and MUO.

Methods: A total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8-16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.

Results: After the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p < 0.001) and diastolic (p = 0.01) blood pressure and a significant increase in high-density lipoprotein cholesterol (HDL-C) (p = 0.005), while the CRFs of the children with MHO had a significant decrease in uric acid (p = 0.04). Additionally, 51.6% of the children with MHO transitioned to the MUO, while 26.8% of the children with MUO crossed over to the MHO at the end of the intervention. Furthermore, the odds of having high systolic blood pressure among children with MUO were 59% lower at week-16 than at baseline (OR = 0.41 (95% CI = 0.18, 0.92), p = 0.03).

Conclusions: Our findings demonstrated that CRFs improved more prominently among children with MUO following the intervention. More importantly, our findings indicate that MHO in children is transient, hence, strategies to protect children against MUO are warranted.

Trial registration: ClinicalTrials.gov NCT02212873.

背景:近年来,人们对肥胖儿童与代谢不健康肥胖(MUO)儿童的代谢表型产生了浓厚的兴趣,前者的特点是没有相关的心脏代谢风险因素(CRF),被称为代谢健康肥胖(MHO)。本研究调查了生活方式干预对MHO和MUO儿童CRFs的影响:共有 102 名 8-16 岁的学龄肥胖儿童(54 名女孩和 48 名男孩)完成了为期 16 周的校本生活方式干预项目 MyBFF@school Phase I。MHO和MUO状态是根据2018年基于共识的标准界定的。在基线和第16周结束时进行了空腹静脉采血、身体成分测量、临床评估和体能测试:干预后,MUO 患儿的 CRFs 有所改善,收缩压显著下降(p 结论:干预后,MUO 患儿的 CRFs 有所改善,收缩压显著下降(p 结论:干预后,MUO 患儿的 CRFs 有所改善:我们的研究结果表明,干预后,肢体缺氧儿童的 CRFs 改善更为明显。更重要的是,我们的研究结果表明,儿童的 MHO 是短暂的,因此有必要制定保护儿童免受 MUO 影响的策略:试验注册:ClinicalTrials.gov NCT02212873。
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Diabetology & Metabolic Syndrome
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